Superficial Second-degree Burns Research Articles

A novel causative factor of injury: severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles

Severe burns related to fires and explosions of lithium-ion batteries of electric motorcycles have not been reported to date. We retrospectively studied 419 patients admitted to our burn intensive care unit from January 2016 to December 2021. Of these 419 patients, 26 (22 male, 4 female; median age, 42 years) had burns related to lithium-ion battery fires and explosions, and all of their injury characteristics were similar to those of traditional flame burns. Lithium-ion battery-related burns were the eighth most common cause of burn injuries among all hospitalized patients. The 26 patients comprised 10 unemployed and 16 employed individuals. Twenty-three patients were injured at home during the battery charging process, and three were injured outdoors (one by a fire while the electric motorcycle was stationary and the others two by a fire while riding the motorcycle). The burn sites were distributed over the whole body; the burn area ranged from 10% to 100% of the total body surface area, and the burn depth ranged from superficial second-degree burns to third-degree burns. Twenty-three patients had inhalation injuries, and ten underwent prophylactic tracheostomy and intubation. Multiple operations were required for wound repair. Although convenient, lithium-ion electric motorcycles can also cause severe burns. To prevent these injuries, we must increase public safety awareness and education, develop new battery energy storage systems and battery management systems, and ensure the safety of batteries. Consumers should be aware of the potential dangers of lithium-ion batteries and comply with related security measures.

Management of Pediatric Superficial Partial-Thickness Burns with Polyhexamethylene Biguanide: Outcomes and Influencing Factors.

Background: In burn care, achieving swift healing with minimal complications remains paramount. This investigation assesses the role of polyhexamethylene biguanide (PHMB) in managing pediatric superficial partial-thickness burns, focusing on the effects of various patient-specific factors on recovery. Methods: Through a retrospective analysis of 27 pediatric cases treated with PHMB, we evaluated the impact of age, burn size, dressing frequency, treatment delay, cold therapy application, and analgesic usage on the time until reepithelialization (TTRE). Results: The majority of patients benefited from early cold therapy, yet only 1 in 3 patients received analgesics. A mean healing time of 8.78 (SD: 2.64) days was observed, with the extent of the burn showing a strong correlation (r: 0.63) to TTRE. Most treatments were managed outpatient, evidenced by a negligible average hospital stay (0.96 days), with recorded no complications. Conclusions: Our findings endorse PHMB as a promising treatment for superficial second-degree burns in young patients, due to the observed stable and rapid wound closure without the association of increased risks. Continued exploration into the optimal application of prehospital interventions and the comprehensive benefits of PHMB in pediatric burn management is necessary. Future research should assess long-term outcomes, including functionality, scar quality, and patient satisfaction.

Surgical management of burn injury patients : Comments on the guidelines on treatment of thermal injuries in adults

The treatment of burn injury patients is aunique challenge for clinicians. The extent of thermal injuries ranges from very small burns to life-threatening burn injuries. Insufficient treatment can result in a substantial impairment in the quality of life. In order to avoid such sequelae a targeted treatment must be carried out. A precise diagnosis determines the necessary treatment. Superficial second-degree burns (2a) not involving the face, hand or joints with atotal body surface area smaller than 10% can usually be treated with modern wound dressings in an outpatient setting. Deep second-degree burns (2b) are an indication for debridement. In addition to the classical surgical procedures with tangential excision, enzymatic debridement can also be employed. Similarly, indeterminate burns (2a/2b) are also considered to be an indication for enzymatic debridement. Third-degree burns are treated with early debridement and skin grafting. These patients can also benefit from special dermal replacement procedures for an improvement of the functional and esthetic results. Due to the long-term visible sequelae of burns, aftercare of these patients is indicated.

Clinical Efficacy of Andrographis paniculata Extracted Scrub Compared With 4% Chlorhexidine Scrub in Burn Wounds: A Prospective Randomized Controlled Trial

Objective: The primary objective of this study is to compare the healing rate between AP soap and 4% Chlorhexidine solution in superficial second-degree burn wounds. The secondary objectives include the analgesic effect and moisturization of these two products. Materials and Methods: Data was collected between 2019 and 2021. Patients aged 18 years and above, with superficial second-degree burns including at least 20% of TBSA, and admitted to the Burn Unit within 24 hours of injury were included. They were randomly assigned to two groups: Andrographis paniculata with Perilla oil liquid soap group (AP group) and 4% Chlorhexidine group (control group). The measurements included percentage of epithelialization, pain score during wound cleansing, itching score after wound cleansing, and dry skin specified symptoms. All patients received standard care for burn wound treatment. Results: A total enrollment was 23 patients in this study (12 in the AP group and 11 in the control group). The median age was 38.5 years. There were no statistically significant differences in age, %TBSA, and initial wound size between both groups (p > 0.05). Although the healing time was similar in both groups, (18.5 vs. 20.1, p=0.347), the AP group had a significantly lower pain score than the control group (4.7 vs. 5.4, p=0.020). Moreover, the AP group demonstrated significant improvements in itching score and SRRC score at 14 days compared to the control group (5.1 vs. 6.0, p 0.039 and 1.08 vs. 1.55, p 0.020, respectively). There were no adverse effects during this study. Conclusion: Patients treated with Andrographis paniculata with Perilla oil liquid soap experienced less pain and better moisturization compared to those treated with the standard 4% chlorhexidine solution, while achieving a comparable healing rate. A future large-scale prospective trial is recommended.

Treatment of superficial and deep partial width second degree burn's wound with allogeneic cord blood platelet gel.

Burns are caused by a variety of mechanisms, including flames, hot liquids, metallurgy, chemicals, electric current, and ionizing and non-ionizing radiation. The most significant burn wound management involves complete repair and regeneration as soon as possible while minimizing infection, contraction, and scarring in the damaged tissue area. Some factors such as delivery of nutrients, growth factors, and oxygen are essential to promote and stimulate the wound healing progress in the burns area. When these factors are not provided, the burn wound undergoes a physiological crisis. The use of growth factors is a promising approach to overcoming this limitation. Umbilical cord blood platelet concentrates are a rich natural source of growth factors. This clinical trial used growth factors released from the lysis of umbilical cord blood platelet concentrates that have a key role in promoting re-epithelization and regeneration of damaged tissues by forming a fibrin network. This study evaluated the effectiveness of allogeneic cord blood platelet gel topical dressing in a group of patients diagnosed with superficial and deep partial thickness (second-degree) burn wounds. Clinical outcomes were compared between the intervention group and a control group of patients with superficial second-degree burn wounds who received the standard routine treatment including paraffin gauze wound dressing and silver sulfadiazine ointment. The study's results showed that the increased rate of recovery and tissue granulation completely promoted to wound healing and burn wound closure, decreased the recovery time, and reduced inflammation and scars caused by burn injuries. However, the use of cord blood platelet gel topical dressing is not currently a routine treatment method in patients suffering from burn wounds. However, the study's results showed that allogenic cord blood platelet gel could be used to treat superficial and deep second-degree burns as a routine treatment. It was also shown that allogenic cord blood platelet gel topical dressing could be a candidate for autograft or after autograft skin transplantation surgery (in donor and recipient sites) instead of skin surgery in some patients. Allogeneic topical wound dressing provides an effective treatment that offers a faster rate of epithelialization and healing of wounds and also decreases patients' scar and inflammation level as well as the length of recovery time. This, finally, leads to better burn wound management and the improved quality of burn wound treatment.

Surgical management of burn injury patients : Comments on the guidelines on treatment of thermal injuries in adults

The treatment of burn injury patients is aunique challenge for clinicians. The extent of thermal injuries ranges from very small burns to life-threatening burn injuries. Insufficient treatment can result in a substantial impairment in the quality of life. In order to avoid such sequelae a targeted treatment must be carried out. A precise diagnosis determines the necessary treatment. Superficial second-degree burns (2a) not involving the face, hand or joints with atotal body surface area smaller than 10% can usually be treated with modern wound dressings in an outpatient setting. Deep second-degree burns (2b) are an indication for debridement. In addition to the classical surgical procedures with tangential excision, enzymatic debridement can also be employed. Similarly, indeterminate burns (2a/2b) are also considered to be an indication for enzymatic debridement. Third-degree burns are treated with early debridement and skin grafting. These patients can also benefit from special dermal replacement procedures for an improvement of the functional and esthetic results. Due to the long-term visible sequelae of burns, aftercare of these patients is indicated.

A fatal case of cutaneous “Atractylis gummifera L.” poisoning: Case report

The “thistle glue” is the leading cause of death by plant intoxication in Morocco, mainly in children. Oral ingestion is the main route of intoxication, whereas dermal application is uncommon. We report one of rare cases of fatal “blue thistle” poisoning in an 8-month-old girl due to cutaneous application on a 5% superficial second-degree burn on her right forearm. She developed an acute liver failure complicated with cerebral oedema and brain death despite symptomatic treatment. The diagnosis was confirmed by toxicological analysis, which revealed the presence of atractyloside in infant urine.

521 Silk A Biological Dressing for Superficial Burns Treatment: Randomized Controlled Trial Versus Silver Sulfadiazine

Abstract Introduction Silver Sulfadiazine is currently the standard treatment for superficial second-degree burns. These burns are common and should not necessarily require hospital treatment. However, caretaking may become an issue: dressing technique is not always mastered by home health care nurses, their practical realization may be more difficult considering the surface to be treated; duration of care can also be too long and painful. We have evaluated the interest of a dressing based on natural silk with this indication. Methods In a preliminary study, we have compared SSD to silk dressing (S) in the treatment of 2nd degree burns. Following diagnosis, the topical to be used was determined by drawing of lots. The SSD associated with fatty gauze was applied and then covered with dry gauzes and bandages. Silk was applied directly on the lesion and then covered with dry gauzes and bandages. Dressings were changed every 48 hours. The SSD was changed with each dressing after cleansing the lesion with saline; the silk one was left in place until healing, only the dry gauzes and bandages were changed. Pain, duration of care and healing time were assessed. Results 80 patients were included 25 men, 15 women (7 to 83years) were treated with SSD; 22 men, 18 women (17 to 84 years) with silk. The average surface area treated was 5% in both groups (1% to 20% SSD) and (1% to 23% S). Pain (EVA) was evaluated between 3 and 4/10 for the SSD group and 0 to 2 for the S group. Dressing duration was 20-30 minutes for the SSD group and 10-15 minutes for the S group. The average healing time was 13 days for both groups. 2 complications, as infections , were observed in each group. Conclusions The flexibility of silk facilitates smooth application on all surfaces and localisations like SSD. Silk treatment has the same healing time as that obtained with SSD, i.e. the physiological healing time of 2nd degree superficial burns. Silk has allowed shorter treatments, because it is technically simple, and less painful as the lesion was never exposed to air. This allowed reduction of analgesics. A larger study should confirm that 2nd degree burns can be managed with silk dressing as outpatients, by home health care nurses, inexperienced in burns and even for larger surfaces and reduce the cost effective of the treatment and the need for painkillers. Applicability of Research to Practice immediate

Pain Management With Topical Ibuprofen in Partial-Thickness Burn Wounds and Effects on Wound Healing: A Prospective Randomized Clinical Study

BACKGROUND: Pain management is important for patient comfort in the treatment of partial-thickness burn wounds. The topical application of ibuprofen provides analgesic and anti-inflammatory effects. PURPOSE: To evaluate the efficacy of ibuprofen-containing foam dressing in partial-thickness burns. METHODS: The study included 50 patients with superficial second-degree burn wounds. Ibuprofen-containing foam dressing was used in 25 patients and paraffin gauze dressing in 25 patients as controls. The visual analogue score (VAS) was evaluated 30 min after dressing. On the 90th day following wound healing, the Vancouver scar scale (VSS) was administered to the patients to evaluate healing and scar formation. RESULTS: The rate of wound healing significantly increased in the study (ibuprofen-containing foam dressing) group compared to control group (8.84±2.97 vs 11.32±4.39, P = 0.010), and the frequency of dressing change significantly decreased in the study group vs control group (1.36±0.49 vs 5.68±2.07, P = 0.000). The oral analgesic needs and VAS scores of the patients were also found to be statistically significantly lower in the study group (5.04 ± 2.44) than for the control group (8.64 ± 1.29, P = 0.000). In the evaluation of the VSS, the total score was lower in the study group, but no statistically significant difference was observed. CONCLUSION: The use of ibuprofen-containing foam dressing in patients with superficial second-degree burns eligible for outpatient follow-up provides effective pain management and increases patient comfort. It does not have a negative effect on wound healing. We consider that ibuprofen-containing foam dressing can be safely used in partial-thickness burns.

Pediatric First-Degree Burn Management With Honey and 1% Silver Sulfadiazine (Ag-SD): Comparison and Contrast.

Background The cardinal area of managing fire wounds is guided by adequately evaluating the burn-induced lesion's profundity and size. Superficial second-degree burns are often treated through daily reinstating with fresh sterile bandagingwith appropriate topical antimicrobials to allow rapid spontaneous epithelialization. Around the world, a wide variety of substances are used to treat these wounds, from honey to synthetic biological dressings. Objective This study intended to determine honey's therapeutic potential compared with 1% silver sulfadiazine (Ag-SD) in arsenal-caused contusion medicament fulfillment. Methods A total of 70 cases were evaluated in this research work after fulfilling the required selection criteria during the study period of January 2014 to December 2014 and January 2017 to December 2017. Purposiveselection criteria were adopted in the studyto select research patients. The patients in Group-1 (n = 35) relied on honey as medication, while patients in Group-2 (n = 35) relied on 1% Ag-SD. Results In Group-1, exudation(68.4%) and sloughing(82.9%) were substantially reduced by Days3 and 5 of therapeutic intervention, respectively. However, in Group-2, a reduction of exudation(17.1%) and sloughing(22.9%) occurred after Days 3 and 5 of treatment, respectively. Completion of the epithelialization process was observed among Group-1 and Group-2 cases. It was detected after Days 7 and 10 of treatment at 36.3% and 77% (Group-1) and 27% and 67% (Group-2), respectively. Around 3 ml of 1% honey was required per body surface area per dressing in Group-1. On the other hand, in Group-2, 2 gm Ag-SD was needed per body surface area per dressing. Conclusion Patients treated with honey found better clinical outcomes in managing superficial partial-thickness burns.

Management of Facial Second-Degree Burns with Nanocellulose-Based Dressing: A Case Series and Systematic Review.

Previous studies have evaluated the effectiveness of bacterial nanocellulose (BNC) for the treatment of thermal injuries, but the synergic effect of platelet-rich plasma (PRP) with BNC-based dressing for burns still requires further investigation. Herein, we evaluated the effectiveness of BNC dressings in the management of facial burns using PRP. Patients with second-degree facial burns were treated with BNC-based wound dressings after debridement. The burn's depth and epithelialization were evaluated by clinical assessment. Besides using the dressings, we injected PRP subcutaneously into the left-hemifacial burns. The right hemiface was only treated with the dressings. Scar quality was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Eight patients were included with superficial second-degree burns in 75% of the cases and deep second-degree burns in 25%. Overall, dressings were placed 3.25 days after the initial insult. None of the patients presented with complications after dressing placement. Dressing changes were not required, and no further surgical management was necessary. The mean time for epithelialization was 11.4 days. During subgroup analysis, we did not find a significant difference in the epithelialization time when comparing BNC-based dressings (11.8 days) to BNC-based dressings + PRP (11 days, p = 0.429). The mean POSAS scores from a patient (17 vs. 12.3, p = 0.242) and surgeon (13.5 vs. 11.3, p = 0.26) standpoint were not significantly different using BNC-based dressings versus BNC-based dressings + PRP. Nanocellulose-based dressings are effective to treat second-degree facial burns. It enhances reepithelialization with optimal esthetic outcomes with or without PRP.

A Safe and Aseptic Method of Benzalkonium Chloride Dilution for Preoperative Facial Skin and Mucosa Preparation

Background: Benzalkonium chloride (BAC) is widely used as an effective antiseptic and disinfectant not only in plastic surgery, but also in everyday life. BAC has an advantage over other antiseptics used for preoperative skin preparation, such as povidone-iodine and chlorhexidine because it causes less irritation of the skin and mucosa and is less toxic. Nonetheless, when BAC is used at higher than desired concentrations, there is a possibility of adverse effects.Methods: Prior to May 2020, 10 mL of 10% BAC was mixed with 1,000 mL of distilled water and diluted to 0.1% on a weekly basis. Afterwards, the method of diluting BAC was modified; for each patient, 1.3 mL of 10% BAC and 100 mL of normal saline were mixed immediately before facial surgery.Results: From March 2007 to May 2020, 0.1% BAC was used for preoperative skin and mucosa preparation. Erroneous dilution of BAC has caused four cases of chemical burns. All the cases were attributed to human error that resulted in higher than desired concentrations of BAC in the antiseptic solution. All the affected patients suffered from first-degree and superficial second-degree chemical burns; however, they were healed uneventfully through proper wound management. Since the application of the dilution method changed since May 2020, no complications have been reported.Conclusion: We have devised a safe and aseptic method for diluting BAC. The new dilution method, which yields a constant concentration of BAC, can be used for preoperative skin and mucosa preparation without accidents.

Human Amniotic Membrane vs Collagen in the Treatment of Superficial Second-degree Burns in Children

The authors compared a 1-time application of bovine collagen and human amniotic membrane (HAM) to treat children with superficial second-degree burns. A prospective, blinded, internally randomized trial of 43 children was conducted. Fresh HAM (prepared in-house at the Christian Medical College, Vellore) and bovine collagen were applied to different halves of each wound and dried naturally to form a hard, shell-like, so-called exoskeleton. The shell was shed as epithelialization occurred beneath it. Clinical examination and serial photographs were used to track progress until the wound healed completely, as well as at 3 and 6 months after the burn injury. Two burns surgeons blinded to the material used evaluated the resulting scars using the Vancouver Scar Scale. The 43 children presented 3 hours after burn injury on average. A 1-time application was successful in 40 children (93%). After the dressing dried, all parents reported that their child was pain free and the exoskeleton could be handled over the burned area. A total of 16 children (37%) with a low-grade fever at the time of application were treated with simple antipyretic agents. Eight children reported itching at the dressing site. The dressing did not take or was removed in 3 children (7%). Minor serous collections occurred in 8 children who subsequently underwent aspiration. The median time to healing was 10 days in both study arms, with no significant difference in scarring between the 2 materials. Children with earlier shedding of the shell had significantly better scar quality (P <.001). Collagen and HAM are safe and provide a one-time ambulatory option for burn dressing with comparable time to healing and scarring. Earlier shedding of the dressing is predictive of better scar quality. Because HAM is inexpensive and simple to prepare and store, it is an excellent choice for use in economically disadvantaged areas where collagen may be unavailable.

Antimicrobial and Immunomodulatory Activity of Herb Extracts Used in Burn Wound Healing: "San Huang Powder".

“San Huang Powder,” a nonsterile milled herb powder, is frequently used to treat burn wounds in traditional Chinese herbal medicine. However, treating a wound with a nonsterile dressing or reagent is not compatible with the current guidelines in modern medicine. Therefore, we investigated the bactericidal and anti-inflammatory activities of four herb extracts used in “San Huang Powder” in vitro. Meanwhile, an in vivo porcine model with superficial second-degree burns was used for the experiments since the size and skin composition of pigs are the closest to that of the human body. The minimal bactericidal concentration (MBC) of the herb extracts was determined. The in vitro assay indicated that Rhubarb and Phellodendron bark extracts decreased the levels of inflammatory cytokines, IL-8, and GM-CSF on LPS-induced HMEC-1 cells. In accordance with this result, the histopathological evaluation results showed that the efficacy of “San Huang Powder” containing both herb materials was much better than the group without Rhubarb. Our results not only provide a basis to understand why “San Huang Powder” has been used to clinically treat wounds without sterilization directly since ancient times but also show the advantages of using multiple herb materials simultaneously on wound sites to prevent infection during treatment. Rhubarb is the recommended ingredient involved in the preparation of “San Huang Powder” to ensure the healing efficacy of burn wounds.

Evaluation the Healing Potential of Oleuropein on Second-Degree Burn Wounds in a Rat Model

Background: Skin burn is one of the most common complications throughout the world. Olive derivatives have been used for the treatment of skin lesions in Iran. Oleuropein is one of the main constituents of olive leaves. Objectives: The aim of the present study was to evaluate the healing effects of oleuropein cream on second-degree burns wounds in a rat model. Methods: This experimental study was performed on 72 male Wistar rats. Superficial second-degree burns were induced in the hairless back of the animals. Then, they were randomly divided into six equal groups. The burnt area in the first group was covered twice a day with normal saline, in the second group with eucerin, in the third group with 1% silver sulfadiazine and in the fourth-sixth groups, oleuropein cream was applied topically. To evaluate the efficacy of treatment, four rats in each group were euthanized on days 4, 9, and 14, and their skin was processed for wound contraction, glutathione (GSH) level, malondialdehyde (MDA) level, hydroxyproline (HP) content, inflammatory factors (transforming growth factor beta [TGF-β] and interleukin 6 [IL-6]), and histological examination. Results: In comparison with untreated control rats, the daily application of 5% oleuropein cream significantly increased wound contraction, HP content, and GSH level over time. Moreover, it caused a significant reduction in inflammatory factors and MDA level. Histological examination confirmed the results. Conclusions: This study indicated that oleuropein has therapeutic value in treating burn wounds and thus supports its traditional use.

Epidemiological profile of burns in children in central and southern Tunisia: A 67-case series

IntroductionBurns are among the most frequent injuries in children. They are a major cause of morbidity and mortality in low- and middle-income countries. This study aimed to describe the epidemiological aspects of burns in this environment and to propose preventive measures. Patients and methodsA retrospective study was conducted between 1 January 2012 and 31 December 2013. It included children less than 16 years old who were hospitalized for burn injuries in our department. We adopted the hospitalization criteria proposed by the French Society for the Study and Treatment of Burns. The data were collected from medical records and concerned both patients and burn characteristics. ResultsWe recorded 67 cases, with 44.7% under 4 years old and boys (61%) more involved than girls (39%). The incidence of burns peaked in winter (31%) and summer (27%). Burns occurred at home in 95% of the cases. Hot liquids were the leading cause of children's burns. The time lapse between the accident and admission to the hospital was less than 24h in 57% of the cases. The average total body surface area (TBSA) burned was 8.8%. Only five patients presented a TBSA≥20%. The depth of the burns was superficial second-degree burns in 59% of cases. The burn involved mainly the upper limbs (65%). The average length of the hospital stay was 20.5 days. Only one patient died from severe sepsis. ConclusionThe lack of specialized burn centers in Tunisia associated with the low socioeconomic level of our population worsened the outcome of pediatric burns. The best solution lies in prevention.

Portable indocyanine green perfusion assessment: An adjunct to visual assessment in burn wound healing in second-degree burns

Aim: To identify perfusion differences between the areas of different depths and to evaluate the potential of portable indocyanine green (ICG) perfusion assessment to determine the likelihood of healing in burns compared with visual assessment. Materials and Methods: This interventional study was carried out at the burn unit and plastic surgery department, from April 2017 to September 2017. A total of 20 patients with superficial and partial thickness burns Results: Of 20 patients, 14 patients did not have any discrepancy with the clinical findings and ICG perfusion assessment. The findings of five patients appeared clinically deep, but perfusion was present which did not require surgical intervention. One patient had patchy perfusion and finally required surgical correction. Conclusion: ICG perfusion assessment appeared to be effective in preventing surgical intervention in patients by differentiating deep to superficial second-degree burns. Proper clinical assessment and ICG perfusion assessment as an adjunct can improve the outcome of burn wound.

CCN1 accelerates re-epithelialization by promoting keratinocyte migration and proliferation during cutaneous wound healing

Re-epithelialization is an essential part of wound healing and has a prominent influence on the prognosis. CCN family member 1 (CCN1 or Cysteine-rich 61, CYR61), a matricellular protein, has a potential role in the wound healing process. However, its role in re-epithelialization remains unclear. The aim of this study was to determine the expression of CCN1 in the epidermis and its effect on keratinocytes during re-epithelialization. CCN1 expression in the wounded skin was analyzed using microarray data from GEO database and detected by immunofluorescence. The results showed upregulated CCN1 during the early stages of wound healing. Human primary keratinocytes were treated with recombinant human CCN1. The results showed that CCN1 promoted keratinocyte migration and proliferation. Moreover, a full-thickness mouse skin wound model and a superficial second-degree burn mouse model treated intracutaneously with CCN1 were used for in vivo studies. Topical treatment with CCN1 protein accelerated wound closure and re-epithelialization. Additionally, longer newly-formed epithelium tongue and elevated expression of PCNA and Ki67 were detected in the CCN1-treated group 4 days post-burn. These results indicate that CCN1 accelerates re-epithelialization by promoting keratinocyte migration and proliferation, and may serve as a novel target to promote re-epithelialization.

Role of Heparin Irrigation in the Management of Superficial Burns with Special Reference to Pain Relief and Wound Healing: A Pilot Study

IntroductionThe objective of this study was to assess the effect of heparin irrigation in the management of superficial first and second degree burns with special reference to pain relief and wound healing.Materials and methodsThis pilot study was carried out over a period of 12 months in a tertiary care centre in South India. The study patients were divided into two groups: the heparin group and the saline control group. In the control group, the burn wound was irrigated with 100 mL of normal saline before the conventional dressing with silver sulfadiazine. In the heparin irrigation group, the wound was irrigated with heparin solution before the conventional dressing. Wound healing was assessed in terms of necrotic tissue score and granulation tissue score. Patient satisfaction in terms of patient satisfaction score, visual analogue scale (VAS) score, and length of hospitalization were compared between the two groups.ResultsA total of 40 patients were analysed in the study, 20 patients in each group. Both the groups were comparable with respect to age, gender, co-morbidities, body mass index (BMI), and degree of burns. Wound healing parameters like necrotic tissue score of six [40% vs. 50%; p = 0.024] and granulation tissue score of four [85% vs. 65%; p= 0.06] were significant in the heparin group compared to the control group. However, the difference was not statistically significant. The mean length of hospitalization between the two groups [10.5 days vs. 12.6 days; p = 0.74] were not statistically significant. Similarly, there was no statistically significant difference between the two groups with respect to the VAS pain score on the seventh dressing day [6.9 vs. 7.3; p= 0.321].ConclusionIn comparison to saline irrigation, heparin irrigation would result in better wound healing in superficial first and second-degree burns. The length of hospital stay in days and VAS pain score on the seventh dressing day were not statistically significant between the two groups.

Nitric oxide promotes epidermal stem cell proliferation via FOXG1-c-Myc signalling

ObjectiveEpidermal stem cells (ESCs) play a critical role in wound repair, but the mechanism underlying ESC proliferation is unclear. Here, we explored the effects of nitric oxide (NO) on ESC proliferation and the possible underlying mechanism. MethodsThe effect of NO (two NO donors, SNAP and spermine NONOate, were used) on cell proliferation was detected using cell proliferation and DNA synthesis assays. Thereafter, expression of FOXG1 and c-Myc induced by NO was determined by immunoblot analysis. pAdEasy-FOXG1 adenovirus and c-Myc siRNA plasmids were infected or transfected, respectively, into human ESCs to detect the effect of FOXG1 and c-Myc on NO-induced cell proliferation. Additionally, NO-induced ESC proliferation in vivo was detected by BrdU incorporation and a superficial second-degree mouse burn model. Moreover, the relationships among NO, FOXG1 and c-Myc were detected by western blotting, real-time PCR and dual luciferase assay. ResultsNO exerted a biphasic effect on ESC proliferation, and 100 μM SNAP and 10 μM spermine NONOate were the optimal concentrations to promote cell proliferation. Additionally, NO-promoted human ESC proliferation was mediated by FOXG1 and c-Myc in vitro and vivo. Furthermore, NO regulated FOXG1 expression through cGMP signalling, and NO-induced transcription of c-Myc was regulated by FOXG1-mediated c-Myc promoter activity. ConclusionThis study showed that the biphasic effect of NO on ESC proliferation as well as NO induced ESC proliferation were regulated by the cGMP/FOXG1/c-Myc signalling pathway, suggesting that NO may serve as a new disparate target for wound healing.